Suture Anchor-Based Quadriceps Tendon Repair May Result in Improved Patient-Reported Outcomes but Similar Failure Rates Compared to the Transosseous Tunnel Technique

Published:December 07, 2022DOI:


      The purpose of this study was to compare failure rates and patient-reported outcomes between transosseus (TO) suture and suture anchor (SA) quadriceps tendon repairs.


      Following institutional review board approval, patients who underwent primary repair for quadriceps tendon rupture with TO or SA techniques between January 2009 and August 2018 were identified from an institutional database and retrospectively reviewed. Patients were contacted for satisfaction (1-10 scale), current function (0-100 scale), failure (retear), and revision surgeries; International Knee Documentation Committee (IKDC) score and Knee Injury and Osteoarthritis Outcomes Score (KOOS) were also collected to achieve a minimum of 2-year follow-up.


      Sixty-four patients (34 SA, 30 TO) were available by phone or e-mail at a mean of 4.81 ± 2.60 years postoperatively. There were 10 failures, for an overall failure rate of 15.6%. Failure incidence did not significantly differ between treatment groups (P = .83). Twenty-seven patients (47% of nonfailed patients) had completed patient-reported outcomes. The SA group reported higher subjective function (SA: 90 [85-100] vs TO: 85 [60-93], 95% CI of difference: –19.9 to –2.1 × 10–5, P = .042), final IKDC (79.6 [50.0-93.6] vs 62.1 [44.3-65.5], 95% CI of difference: –33.0 to –0.48, P = .048), KOOS Pain (97.2 [84.7-97.2] vs 73.6 [50.7-88.2], 95% CI of difference: –36.1 to –3.6 × 10–5, P = .037), Quality of Life (81.3 [56.3-93.8] vs 50.0 [23.4-56.3], 95% CI of difference: –50.0 to –6.2, P = .026), and Sport (75.0 [52.5-90.0] vs 47.5 [31.3-67.5], 95% CI of the difference: –45.0 to –4.1 × 10–5, P = .048).


      There is no significant difference in failure rate between transosseus and suture anchor repairs for quadriceps tendon ruptures (P = .83). Most failures occur secondary to a traumatic reinjury within the first year postoperatively. Despite the lack of difference in failure rates, at final follow-up, patients who undergo suture anchor repair may report significantly greater subjective function and final IKDC, KOOS Pain, Quality of Life, and Sport scores.

      Level of Evidence

      III, retrospective cohort study.
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        • Reito A.
        • Paloneva J.
        • Mattila V.M.
        • Launonen A.P.
        The increasing incidence of surgically treated quadriceps tendon ruptures.
        Knee Surg Sports Traumatol Arthrosc. 2019; 27: 3644-3649
        • Garner M.R.
        • Gausden E.
        • Berkes M.B.
        • Nguyen J.T.
        • Lorich D.G.
        Extensor mechanism injuries of the knee: Demographic characteristics and comorbidities from a review of 726 patient records.
        JBJS. 2015; 97: 1592-1596
        • Roberts A.
        • Ketz J.
        Rates and risk factors for failure of surgical repair of the knee extensor mechanism.
        J Orthop Trauma. 2020; 34: e203-e207
        • Kindya M.C.
        • Konicek J.
        • Rizzi A.
        • Komatsu D.E.
        • Paci J.M.
        Knotless suture anchor with suture tape quadriceps tendon repair is biomechanically superior to transosseous and traditional suture anchor–based repairs in a cadaveric model.
        Arthroscopy. 2017; 33: 190-198
        • Sherman S.L.
        • Copeland M.E.
        • Milles J.L.
        • Flood D.A.
        • Pfeiffer F.M.
        Biomechanical evaluation of suture anchor versus transosseous tunnel quadriceps tendon repair techniques.
        Arthroscopy. 2016; 32: 1117-1124
        • Petri M.
        • Dratzidis A.
        • Brand S.
        • et al.
        Suture anchor repair yields better biomechanical properties than transosseous sutures in ruptured quadriceps tendons.
        Knee Surg Sports Traumatol Arthrosc. 2015; 23: 1039-1045
        • Lighthart W.A.
        • Cohen D.A.
        • Levine R.G.
        • Parks B.G.
        • Boucher H.R.
        Suture anchor versus suture through tunnel fixation for quadriceps tendon rupture: A biomechanical study.
        Orthopedics. 2008; 31 (441-441)
        • Brossard P.
        • Le Roux G.
        • Vasse B.
        Acute quadriceps tendon rupture repaired by suture anchors: Outcomes at 7 years’ follow-up in 25 cases.
        Orthop Traumatol Surg Res. 2017; 103: 597-601
        • Plesser S.
        • Keilani M.
        • Vekszler G.
        • et al.
        Clinical outcomes after treatment of quadriceps tendon ruptures show equal results independent of suture anchor or transosseus repair technique used—A pilot study.
        PLoS One. 2018; 13e0194376
        • O’Dowd J.A.
        • Lehoang D.M.
        • Butler R.R.
        • Dewitt D.O.
        • Mirzayan R.
        Operative treatment of acute patellar tendon ruptures.
        Am J Sports Med. 2020; 48: 2686-2691
        • Carlson Strother C.R.
        • LaPrade M.D.
        • Keyt L.K.
        • Wilbur R.R.
        • Krych A.J.
        • Stuart M.J.
        A strategy for repair, augmentation, and reconstruction of knee extensor mechanism disruption: A retrospective review.
        Orthop J Sports Med. 2021; 9 (23259671211046625)
        • Harris J.D.
        • Abrams G.D.
        • Yanke A.B.
        • Hellman M.D.
        • Erickson B.J.
        • Bach B.R.
        Suture anchor repair of quadriceps tendon rupture.
        Orthopedics. 2014; 37: 183-186
        • Hart N.D.
        • Wallace M.K.
        • Scovell J.F.
        • Krupp R.J.
        • Cook C.
        • Wyland D.J.
        Quadriceps tendon rupture: a biomechanical comparison of transosseous equivalent double-row suture anchor versus transosseous tunnel repair.
        J Knee Surg. 2012; 25: 335-340
        • Mille F.
        • Adam A.
        • Aubry S.
        • et al.
        Prospective multicentre study of the clinical and functional outcomes following quadriceps tendon repair with suture anchors.
        Eur J Orthop Surg Traumatol. 2016; 26: 85-92
        • Mehta A.V.
        • Wilson C.
        • King T.S.
        • Gallo R.A.
        Outcomes following quadriceps tendon repair using transosseous tunnels versus suture anchors: A systematic review.
        Injury. 2021; 52: 339-344
        • Onggo J.R.
        • Babazadeh S.
        • Pai V.
        Smaller gap formation with suture anchor fixation than traditional transpatellar sutures in patella and quadriceps tendon rupture: A syste-matic review.
        Arthroscopy. 2022; (S0749-8063(22)00015-9 doi: 10.1016/j.arthro.2022.01.012)